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� 4 <br />y. . <br />NOTICE• of 'RESTRICTION OF USE <br />and Notice of Right to Appeal <br />DATE: (5 9,V 7I a,_ <br />LOCATION (PARK /OPEN SPACE): <br />TIME: <br />OA /C �l <br />CASE #: <br />6 S 7/U <br />Potn 6 6 /a ele-. <br />w <br />a <br />Name: Last First Middle <br />3&r 6 P ff PJ3 (Pa 019 7 <br />DOB: <br />Race /Sexi <br />U <br />Res. Addre � City <br />37 qr10 <br />State <br />zip <br />Res. Phone: <br />33;5-1 <br />work Phone: <br />Under the authority of Administrative Order No. 58- 03 -24 -F and Park and Open Space Rule R- 1.005(3), you are hereby <br />notified that you are prohibited from (check box): <br />D Entering in or using all City of Eugene parks, open spaces or facilities. <br />The basis for this Notice of Restriction of Use is that on (� ��� r� you violated Section of the Park <br />and Open Space Rules, and/or Section �' � 902 of the Eugene Code, 197:3�,�� "and/or ORS To wit, you: <br />4 <br />(Description of the violation.) <br />This restriction of use is effective beginning on � �� » and shall remain in effect until 0 O - 7/ -3. <br />arx,�a�M <br />If you enter in or use any City of Eugene park, open ,dace or facility during the effective period of this Notice, you may be <br />arrested and charged with criminal trespass in the send degree. <br />Pursuant to Park and Open Space Rule R- 1.w* are entitled to an informal hearing to contest this Notice. A request for an <br />informal hearing must be made in writing;d filed with the Parks &Open Space Division Director ( "the Division Director ") <br />within 48 hours (exclusive of weekends) of receipt of this Notice at the following address: 1820 Roosevelt, Blvd., Eugene, OR <br />97402. <br />The Division Director shall schedule a time and place for the informal hearing to be conducted, which shall be not more than <br />72 hours (exclusive of weekends) of receipt of the request for hearing. At the informal hearing the Division Director will only <br />consider testimony from you, City personnel involved in the incident that resulted in this Notice, and other witnesses to the <br />incident. The Division Director may exclude anyone, other than you and those presenting testimony, from the informal hearing. <br />This Notice shall remain in effect pending any requested hearing. <br />This Notice of Exclusion was delivered to the person named at the top of this Notice tfChe date and time shown above by: <br />(S�ignatur of 'person issuing /delivering notice) <br />I hereby acknowledge receipt of the above Notice on the date and time i <br />I <br />•• c <br />White Copy: Public works Green Copy: File Yellow Copy: Report Copy Pink Copy: Recipient <br />tcateda Eve. <br />(Sigriaturd'of person being issued the notice) <br />�. 4 . <br />Gold Copy: Officer Appeal notice Rev. 04103 <br />